American Nursing Care LLC

“Infection Prevention CFR(s): 484.70(a) Standard: Infection Prevention. The HHA must follow accepted standards of practice, including the use of standard precautions, to prevent the transmission of infections and communicable diseases. This Standard is not met as evidenced by: Based on record review, observation, and interview, the agency failed to ensure an infection control policy was implemented appropriately to prevent cross-contamination of equipment used and ensure safety of personnel and patients for 3 of 7 home visits (Patients #1, #6, and #7). Findings include: 1. Review of a document titled “Bag Technique,” specified employees of the agency are to prepare a clean and dirty area near the work bag and establish a receptable for disposal of items; wipe entire stethoscope with alcohol or cleansing agent, per manufacturer recommendations, after each use before returning to the bag; clean blood pressure cuffs after each patient use with a hospital grade disinfectant wipe, per manufacturer recommendations; transport contaminated equipment or equipment that cannot be cleaned in the patient’s home, in an impermeable sealed plastic bag placed in the dirty area of the car, to the home health agency for disinfection. 2. A review of Medline Micro-kill One Germicidal Alcohol Wipes manufacturer’s guidelines and recommendations written on the package provided by RN 1, indicated “To disinfect hard, non-porous surfaces, use one or more wipes as necessary to thoroughly wet the surface to be treated. Treated surfaces must remain visibly wet for one minute to achieve complete disinfection”. The guidelines did not provide directives for use on soft or porous surfaces. 3. Review of Clorox Healthcare Germicidal Wipes manufacturer’s guidelines for use, specified Application: Wipe the surface with a fresh wipe until it is completely wet. Contact Time (Dwell Time): Bacteria (e.g., MRSA, VRE): 30 seconds. Viruses (e.g., Norovirus, Influenza): 1 minute. C. difficile spores and Fungi: 3 minutes. Drying: Allow the surface to air dry. For use on hard, nonporous surfaces. 4. During a home visit with Patient #1 on 02/26/2026 at 11:00 AM, PT 2 disinfected vital sign equipment (blood pressure cuff, stethoscope, oxygen saturation device, and thermometer) after use, with hand sanitizer, before laying it out to dry on a dirty barrier. PT 2 failed to ensure the cleaned equipment was placed on a new clean barrier to dry before it was put away into the clean section of the nursing bag. An interview with PT 2 after the home visit indicated he/she did not realize at the time that the cleaned equipment was put back on the barrier that had been used for the equipment prior to it being cleaned. PT 2 acknowledged the cleaned equipment should have been placed on a new clean barrier. PT 2 cleaned the equipment and inside of nursing bag once back to personal vehicle and laid out on a clean surface to ensure it was properly done before use on the next patient after discussion about the practice in the home. 5. During a home visit with Patient #6 on 02/27/2026 at 10:00 AM, PT 1 disinfected vital sign equipment (blood pressure cuff, stethoscope, oxygen saturation device, and thermometer) after use, with Clorox Healthcare Germicidal Wipes. PT 1 failed to ensure each item remained visibly wet for a minimum of 30 seconds before laying items on a barrier to air dry and putting them away into the clean section of the equipment bag. During an interview with PT 1 prior to him/her disinfecting vital sign equipment at the home visit, he/she indicated he/she uses Clorox Healthcare Germicidal Wipes instead of the wipes the home health agency offers to order for personnel. PT 1 indicated staff are allowed to use any wipes they want for cleaning equipment. He/She indicated being unsure what the manufacturer’s guidelines are for proper disinfection of healthcare equipment. PT 1 indicated he/she would ask the home health agency’s CM later to find out. 6. During a home visit with Patient #7 on 02/27/2026 at 8:58 AM, RN 1 disinfected vital sign equipment (blood pressure cuff, stethoscope, oxygen saturation device, and thermometer) after use, with Medline Micro-kill One Germicidal Alcohol Wipes. RN 1 failed to ensure each item remained visibly wet for one (1) minute before laying out on a barrier to air dry before it was put away into the clean section of the nursing bag. 7. During an interview on 03/02/2026 at 10:54 AM, the Administrator and Regional Director of Clinical Services indicated they had been informed by PT 1 of the infection control issue that occurred during home visit #2 and acknowledged it was cross contamination and the clean equipment should have been laid out to dry on a different clean barrier. Both indicated cleaning wipes used by clinicians to disinfect equipment should be used appropriately according to the manufacturer’s guidelines. 8. During an interview on 03/02/2026 at 4:01 PM, the Administrator indicated the agency has already scheduled a staff education date to reinforce infection control procedures as discussed with the Alternate Administrator earlier. She indicated the agency offers home health staff to order wipes from the agency so everyone has access to the same wipes with the same directions for use, free of charge. She indicated being unsure why some staff choses to buy and use their own and will follow up and educate staff on correct expectations for use. 410 IAC 17-12-1(m)”

“HHA administrator contact information CFR(s): 484.50(a)(1)(ii) (ii) Contact information for the HHA administrator, including the administrator’s name, business address, and business phone number in order to receive complaints. This Element is not met as evidenced by: Based on record review and interview, the agency failed to furnish the patient and/or patient’s legal representative with the contact information for the home health agency administrator, to include: the administrator’s name, business address, and business phone number for the purpose of receiving complaints, prior to the patient receiving care for 7 of 7 home visits conducted (Patient #1, #2, #3, #4, #5, #6, #7). Findings include: 1. Review of the agency’s admission packet evidenced a welcome letter provided by the agency to patients. The document specified patients should contact the agency with anything about their care they would like to discuss. The document specified management staff of the agency as the Market Director of Operations and the Director of Clinical Services names; the document failed to specify who the agency Administrator was and name/contact information for the Administrator. 2. During a home visit with Patient #1 on 02/26/2026 at 11:00 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. Interview with Patient #1 during the home visit indicated an inability to identify who the Administrator for agency and thought maybe it was PT 1 who had been out to do the admission and completed visits. 3. During a home visit with Patient #2 on 02/26/2026 at 12:00 PM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. Interview with Patient #2’s primary caregiver during the home visit indicated he/she could not identify who the Administrator of the home health agency was. 4. During a home visit with Patient #3 on 02/26/2026 at 10:30 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. Interview with Patient #3’s primary caregiver during the home visit indicated he/she could not identify who the Administrator of the home health agency was. 5. During a home visit with Patient #4 on 03/02/2026 at 8:45 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. Interview with Patient #4 during the home visit indicated he/she could not identify who the Administrator of the home health agency was. 6. During a home visit with Patient #5 on 02/27/2026 at 10:21 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. An interview attempted with Patient #5 during the home visit was difficult to complete but there was no evidence the patient could identify the Administrator of the agency. 7. During a home visit with Patient #6 on 02/27/2026 at 10:00 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. Interview with Patient #6 during the home visit indicated he/she could not identify who the Administrator of the home health agency was. 8. During a home visit with Patient #7 on 02/27/2026 at 8:58 AM, a review of the patient’s folder provided by the agency failed to evidence the agency informed the patient of the name and contact information for the administrator. 9. During an interview on 03/03/2026 at 9:38 AM, the Regional Director of Clinical Services acknowledged that patients might not recognize who the Administrator for the agency was based on the Welcome Letter provided in the admission packet. He/She also stated it was not clear the Director of Clinical Services and Administrator were the same person because there was nothing to specifically indicate that. The Administrator indicated the assumption clinicians introduced him/her to patients as the Director of Clinical Services.”

“Responsible for all day-to-day operations CFR(s): 484.105(b)(1)(ii) (ii) Be responsible for all day-to-day operations of the HHA; This Element is not met as evidenced by: Based on record review and interview, the agency failed to ensure the administrator was actively involved in the responsibilities of running the day-to-day operations with clear and defined duties outlined for leadership roles of administrative staff for 1 of 1 home health agency. Findings include: During an interview on 02/27/2026 at 1:54 PM, the Administrator indicated she doesn’t have the ability to access the Alternate Administrator’s performance evaluations because the Alternate Administrator also holds the corporate title of Regional Director of Operations. She indicated the Regional Director of Operations is above her title as Administrator and would be considered one of her superiors. On 02/27/2026 at 2:09 PM, the surveyor received an email from the Human Resources Business Partner. The email indicated human resources sent a copy of the Alternate Administrator’s performance evaluation directly to surveyors to maintain confidentiality due to the agency’s reporting structure and the Alternate Administrator/Alternate Clinical Manager being the Administrator’s manager. Review of a document titled “Administrative Control,” specified the Market Director of Operations is responsible for overall operations. They have the authority and responsibility for the overall operation and services of the Home Health Agency. The Administrator/Backup Administrator organizes and directs the home health agency’s ongoing functions and maintains ongoing liaison among the governing body/owner and the personnel. The document included a page titled “Administrative Replacement,” specifying in the absence of the Administrator, the Alternate Administrator will act as the replacement. Review of a document in the agency’s admission packet, revised 04/14/2025, specified the management staff at the home health agency as the Market Director of Operations and the Director of Clinical Services. During an interview on 03/02/2026 at 4:01 PM, the Administrator indicated she is responsible for the clinical operations of the agency. The Market Director of Operations is non-clinical and oversees agency operations. During an interview on 03/02/2026 at 4:21 PM, the Administrator indicated she doesn’t have a separate job description for the role of Administrator. She indicated item number twenty-three of the Director of Clinical Services job description, allows her to be listed as Administrator of the home health agency for state regulatory purposes. 410 IAC 17-12-1(c)”

“Coordinate patient care CFR(s): 484.105(c)(2) Coordinating patient care, This Element is not met as evidenced by: Based on observation, record review, and interview, the CM failed to ensure personnel effectively provided patient care coordination for 1 of 1 home health care agency. Findings include: During a home visit with Patient #2 on 02/26/2026 at 11:53 AM, the patient’s primary caregiver indicated he/she has chronic back issues and has bad days leaving it almost impossible to give the patient bathing assistance. He/She indicated it would be helpful to have assistance a couple of days per week with bathing Patient #2. The patient’s primary caregiver asked MSW 1 if when he/she received a replacement admission folder from the home health agency (he/she misplaced the previous one provided), if he/she contacted the home health agency’s phone number, if some days of the week the patient could receive bathing assistance. MSW 1 indicated to the patient’s primary caregiver that the patient’s insurance does not cover waiver services for bathing aides and contacting the home health agency would not result in help with patient bathing. During an interview on 02/26/2026 at 1:15 PM, MSW 1 acknowledged Patient #2’s primary caregiver indicated he/she could use an aide’s assistance for bathing at times. MSW 1 indicated the home health agency does not offer HHA services because they are unable to keep aides employed as it is difficult to find HHAs in the area. He/She indicated being unsure if the home health agency is contacting other agencies to find HHA services for patients if they can’t service the aide hours. Review of a document titled “Case Conferences and Coordination of Services,” specified agency employees regularly communicate to ensure their efforts are coordinated effectively and support the objectives outline in the Plan of Care. During an interview on 02/28/2026 at 10:38 AM, PT 1 indicated if he/she sees a patient needs HHA services, he/she would provide the patient and/or family with contact information for other home health agencies to patient or family members to find HHA services During an interview on 03/02/2026 at 9:38 AM, LPN 1 indicated if a patient or family requests HHA for safety concerns, he/she was taught to use the OT protocol which consists of contacting the physician for an order for OT to assess the patient for ADL needs. If HHA services are needed long term, there are some non-skilled agencies in the area the home health agency uses if HHA is needed. The clinical record for Patient #2, certification period 02/11/2026 – 04/11/2026, failed to evidence documentation from MSW 1 of the patient’s primary caregiver’s request for help with patient bathing or communication with the patient’s care team related to the bathing request. During an interview on 03/02/2026 at 1:10 PM, the Alternate Administrator indicated if a patient has a change in care need or requests HHA services, staff is to obtain an OT order for evaluation and treatment; if the HHA need will be short term, the OT helps with bathing and ADLs. If an HHA is needed more long term for a patient, the agency is to reach out to other agencies in the area to find aide services for patients. During an interview on 03/03/2026 at 11:03 AM, the Administrator indicated RNs are assigned to patients based on their zip code; every patient should have an RN case manager unless they are therapy only and then the PT acts as the case manager. All disciplines working with a patient should know who to contact with patient changes and that is the expectation. During an interview on 03/03/2026 at 11:36 AM, the Administrator indicated the agency does not have a policy for RN or PT case management expectations. She provided a job description for LPN and indicated it states the expectation is to collaborate and coordinate patient care as a team with the designated RN case manager and other disciplines following the plan of care. She indicated the expectation of all disciplines providing care to coordinate care with the patient’s case manager. Review of a document titled “Job Description: Licensed Practical Nurse,” specified a key job responsibility is to collaborate and coordinate patient care as a team with the designated RN Case Manager and other disciplines following plan of treatment and patient care plan, focusing on the right care at the right time for the right outcomes.”

“Interventions and patient response CFR(s): 484.110(a)(2) All interventions, including medication administration, treatments, and services, and responses to those interventions; This Element is not met as evidenced by: Based on observation, record review, and interview, the agency failed to ensure staff recorded clinical notes to include complete information obtained and interventions performed during 1 of 1 home visit with a MSW (Patient #2). Findings include: During a home visit with Patient #2 on 02/26/2026 at 11:53 AM, the patient’s primary caregiver indicated he/she has chronic back issues and has bad days leaving it almost impossible to give the patient bathing assistance. He/She indicated it would be helpful to have assistance a couple of days per week with bathing Patient #2. The patient’s primary caregiver asked MSW 1 if when he/she received a replacement admission folder from the home health agency (he/she misplaced the previous one provided), if he/she contacted the home health agency’s phone number, if some days of the week the patient could receive bathing assistance. MSW 1 indicated to the patient’s primary caregiver that the patient’s insurance does not cover waiver services for bathing aides and contacting the home health agency would not result in help with patient bathing. During an interview on 02/26/2026 at 1:15 PM, MSW 1 acknowledged Patient #2’s primary caregiver indicated he/she could use an aide’s assistance for bathing at times. MSW 1 indicated the home health agency does not offer HHA services because they are unable to keep aides employed as it is difficult to find HHAs in the area. He/She indicated being unsure if the home health agency is contacting other agencies to find HHA services for patients if they can’t service the aide hours. The clinical record for Patient #2, certification period 02/11/2026 – 04/11/2026, failed to evidence documentation from MSW 1 of the patient’s primary caregiver’s request for help with patient bathing or communication with the patient’s care team related to the bathing request. During a telephone interview on 03/02/2026 at 12:09 PM, MSW 1 indicated if a patient on service needs a HHA or family requests a HHA, he/she would ask/email OT about the request. He/She indicated having the option to reach out to the Manager of Clinical Services since the current OT has only been with the home health agency for a month or two. He/She indicated OT, PT, and RN can order HHA services for patients and the MSW does not. MSW 1 indicated being a PRN (work as needed) staff member and not having the full knowledge to answer the question; indicated knowing the patient must fall under guidelines to qualify for HHA services. He/She indicated Patient #2 will be seen again later in the week and will revisit the conversation and document at that time. MSW 1 indicated most patients ask for HHA services even if they don’t qualify. He/She indicated the assessment for HHA service need is in the therapy assessment since PT and OT provide supervision for HHAs. He/She indicated not thinking about the need or request for HHA assistance during the home visit on 02/27/2024 with Patient #2 because the patient already had weekly OT visits scheduled and didn’t think it was the responsibility of the MSW since the OT was ordered already.”